Hepatitis cases responsible for 93% of prison disease reports

New figures from Public Health England (PHE) reveal hepatitis B and C cases accounted for 1,174 of 1,268 infectious diseases reported in English prisons during 2014.

The number of single reports of infectious diseases made to PHE has more than doubled since 2011 (549 reports). The increase in reports reflects significant improvements in testing for hepatitis and other blood borne viruses (BBV) in prisons, which in a major change is moving from an ‘opt-in’ to an ‘opt-out’ policy to help reduce transmissions.

Preliminary results from prisons who have already introduced the ‘opt out’ policy reveal a near doubling of BBV testing. These early adopters report 21% of new entrants were tested for hepatitis C and 22% for hepatitis B in the first phase, compared to 11% for hepatitis C and 12% for hepatitis B previously. The majority of early adopters stated that the policy has helped them identify people who would otherwise have remained undiagnosed.

The prison population has a higher incidence of hepatitis C than the general population (8% compared to 2%), therefore diagnosing and treating hepatitis C and other BBVs in prisons is designed to help reduce transmission both in prisons and in the community.

These new figures are published today (15 June 2015) in PHE’s health and justice 2014 report, which details the important changes in the health and justice system and discusses the public health needs of people in prisons and other prescribed places of detention. This group experience a number of health inequalities, including suffering a higher burden of chronic illnesses, mental health and substance misuse problems than the general public.

Improving health in prisons can help deal with entrenched inequalities, ultimately benefiting the health of the communities to which the majority of prisoners return, while tackling substance misuse problems in prisons also helps to reduce re-offending rates.

The prison population is around 85,000 at any one time, but the number of new receptions for 2013 to 2014 amounted to a total of 204,941, highlighting the highly mobile nature of the prison population – both between sites and between prison and the community. The majority of prisoners only serve a sentence of 6 months or less, presenting a real challenge to improving their health.

The report flags concerns that health improvements in prison may be lost when a prisoner returns to the community and shows the important role that local authorities have in ensuring continuity of care. In total 39% of local authorities have prisons within their area, however all local health bodies have a responsibility for people in their communities who are in contact with the criminal justice system.

Professor Kevin Fenton, Director of Health and Wellbeing at PHE said:

Improving the health of prisoners delivers a ‘community dividend’ by benefiting the areas to which most prisoners eventually return. By intervening in prisons we can help prevent the spread of infectious diseases, lighten the burden on the NHS from long standing problems, and reduce re-offending linked to poor health. This principle underpins our work in prisons and is no more evident than in our vital work on blood-borne viruses which will help reduce infection rates inside and outside prison walls.

We are world leading in our ability to collect surveillance data on infectious diseases from the whole English prison system in near real-time, allowing us to quickly identify and respond to emerging threats. With this experience PHE has a leadership role with the World Health Organization’s Health in Prisons Programme, helping other countries across Europe in their efforts to improve the quality of prisoner health.

Background

Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Website: www.gov.uk/phe. Twitter: @PHE_uk, Facebook: www.facebook.com/PublicHealthEngland

From April 1 2013, NHS England became responsible for commissioning all health services (with the exception of some emergency care, ambulance services, out of hours and 111 services) for people in prisons in England through ‘Health and Justice’ commissioning teams in 10 of NHS England’s 27 area teams, supported by a small national Health and Justice team.

The PHE health and justice team will work in partnership with NHS England commissioners in support of their responsibility for commissioning public health functions in prisons, at national and local level. In addition to the national team, 10 health and justice public health specialists will be located in PHE Centres, mapping to those 10 NHS England area teams with specialist health and justice commissioning teams.

While PHE has an important role in providing expert public health advice guidance and support tools to NOMS and NHS England which supports commissioning in the context of this agreement, it does not have any direct responsibility for commissioning or performance management of healthcare services in secure and detained settings, nationally or locally.

PHE is committed to working with local authorities to support the Transforming Rehabilitation programme which aims to improve integration between health providers in custody and in the community.

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